Focus shifts to next part of GOP vow

To dodge the “party of no” label Democrats stuck on them, Republicans ran in 2010 on a promise to “repeal and replace” the Democrats’ health care law with something better. And now they’ve got to deliver on the “replace” part — even though their base has never embraced health care as one of its core issues.

“They just can’t say, ‘Sorry, if you elect us, we’re going to have nothing.’ For independent voters, they have to have something,” said Robert Blendon, a Harvard University professor who studies public opinion on health policy. “To be a majority party, they have to do something about one of the biggest issues of our time.”

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The problem for the GOP is that health care has never been as important to Republican voters as it is to Democratic voters or independents. In every presidential election over the past 20 years except in 1992, Republican voters have ranked health care lower on their list of priorities than Democrats and independents have.

And with the country — and especially Republicans — in a “no more spending” mood, the GOP faces an uphill fight in crafting an alternative plan that meets at least some goals of reform without raising Republican hackles.

With the repeal vote behind them, House Republican leaders Thursday will punt the “replace” part to their committee chairman, who will have to get voters interested in health care and not push further than the base is willing to go.

Republican voters are more likely to support smaller, piecemeal measures than any larger package. That dilemma may explain why, so far, House Republicans are mostly talking about the same ideas they proposed in November 2009, in the substitute they offered to the Democratic health care bill. And it’s not clear they’ll go much beyond that when they write their “replace” bills, unless their new members demand a fresh approach.

“A lot of those key components, you probably will see again,” said House Republican Conference Chairman Jeb Hensarling of Texas. “But there are 87 new [GOP] freshmen, and they deserve to be heard.”

The Republican substitute from 2009 was a collection of the smaller ideas the party has been advocating for years: letting health insurers sell policies across state lines, letting small businesses join purchasing pools, expanding health savings accounts and rewriting medical malpractice laws. It would have dealt with pre-existing conditions by setting up high-risk pools to offer people special coverage — much like the temporary risk pools the current law sets up in each state until 2014, when insurers won’t be able to reject people with health problems anymore.